ALCOHOL DEPENDENCE

Alcohol dependence

Artículo para estudiantes Enfermería II

Alcohol dependence is a psychiatric diagnosis (a substance related disorder DSM-IV) describing an entity in which an individual uses alcohol despite significant areas of dysfunction, evidence of physical dependence, and/or related hardship, and also may cause stress and bipolar disorder.

Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing. It is medically considered a disease, specifically a neurological disorder, and in medicine several other terms are used, specifically "alcohol abuse" and "alcohol dependence" which have more specific definitions. In 1979 an expert World Health Organization committee discouraged the use of "alcoholism" in medicine, preferring the category of "alcohol dependence syndrome". In the 19th and early 20th centuries, alcohol dependence in general was called dipsomania, but that term now has a much more specific meaning.^[3] People suffering from alcoholism are often called "alcoholics". Many other terms, some of them insulting or informal, have been used throughout history. The World Health Organization estimates that there are 140 million people with alcoholism worldwide.^[4][5]

Alcoholism is called a "dual disease" since it includes both mental and physical components. The biological mechanisms that cause alcoholism are not well understood. Social environment, stress, mental health, family history, age, ethnic group, and gender all influence the risk for the condition. Long-term alcohol abuse produces changes in the brain's structure and chemistry such as tolerance and physical dependence. These changes maintain the person with alcoholism's compulsive inability to stop drinking and result in alcohol withdrawal syndrome if the person stops. Alcohol damages almost every organ in the body, including the brain. The cumulative toxic effects of chronic alcohol abuse can cause both medical and psychiatric problems.

Causes

A complex mixture of genetic and environmental factors influences the risk of the development of alcoholism.  Genes that influence the metabolism of alcohol also influence the risk of alcoholism, and may be indicated by a family history of alcoholism. One paper has found that alcohol use at an early age may influence the expression of genes which increase the risk of alcohol dependence. Individuals who have a genetic disposition to alcoholism are also more likely to begin drinking at an earlier age than average.  Also, a younger age of onset of drinking is associated with an increased risk of the development of alcoholism, and about 40 percent of alcoholics will drink excessively by their late adolescence. It is not entirely clear whether this association is causal, and some researchers have been known to disagree with this view. A high testosterone concentration during pregnancy may be a risk factor for later development of alcohol dependence.

Severe childhood trauma is also associated with a general increase in the risk of drug dependency. Lack of peer and family support is associated with an increased risk of alcoholism developing. Genetics and adolescence are associated with an increased sensitivity to the neurotoxic effects of chronic alcohol abuse. Cortical degeneration due to the neurotoxic effects increases impulsive behavior, which may contribute to the development, persistence and severity of alcohol use disorders. There is evidence that with abstinence, there is a reversal of at least some of the alcohol induced central nervous system damage.

^TREATMENT

Treatment of alcoholism takes several steps. Because of the medical problems that can be caused by withdrawal, alcohol detoxification is carefully controlled and may involve medications such as benzodiazepines such as diazepam (Valium). People with alcoholism also sometimes have other addictions, including addictions to benzodiazepines, which may complicate this step. After detoxification, other support such as group therapy or self-help groups are used to help the person remain sober. Thombs (1999) states according to behavioral sciences alcoholism is described as a “maladaptive behavior”. He explains this must not be confused with “misbehavior”. Behavioral scientists explain that addicts have a behavior pattern that may lead to destructive consequences for themselves, their families and society. This does not label addicts as bad or irresponsible. Compared with men, women are more sensitive to alcohol's harmful physical, cerebral, and mental effects.

DIAGNOSIS

According to the DSM-IV criteria for alcohol dependence, at least three out of seven of the following criteria must be manifest during a 12 month period:

·         Withdrawal symptoms or clinically defined Alcohol Withdrawal Syndrome

·         Use in larger amounts or for longer periods than intended

·         Persistent desire or unsuccessful efforts to cut down on alcohol use

·         Time is spent obtaining alcohol or recovering from effects

·         Social, occupational and recreational pursuits are given up or reduced because of alcohol use

·         Use is continued despite knowledge of alcohol-related harm (physical or psychological

SOCIAL EFFECTS

 The social problems arising from alcoholism are serious, caused by the pathological changes in the brain and the intoxicating effects of alcohol. Alcohol abuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape, burglary and assault. Alcoholism is associated with loss of employment, which can lead to financial problems. Drinking at inappropriate times and behavior caused by reduced judgment, can lead to legal consequences, such as criminal charges for drunk driving or public disorder, or civil penalties for tortious behavior, and may lead to a criminal sentence.